Full Report

The pilot phase began in June 2012 and was completed
in March 2013. Nearly 20 frontline and department staff
were involved in three specific activities: 40
• Creating a self-management training package
• Delivering virtual and in-person SMS training
to primary care service teams (also known
as pilot teams)
• Implementing SMS activities as part of routine care
in each pilot site
Our approach
The improvement team began by identifying
appropriate outcome measures and SMS training
methods. The team selected the 5As based in part
on its effectiveness and wide adoption for providing
support to clients with a range of chronic health
conditions in primary care settings. 41 A five-step
communication and action cycle – assess, advise,
agree, assist, arrange – the 5As was originally
developed as a smoking cessation strategy and is
endorsed by the Registered Nurses’ Association of
Ontario (RNAO) as a clinical SMS best practice. 42
Each pilot team worked within its current
budget and with existing staff resources.
Providing support for innovation
Each pilot team worked within its current budget and
with existing staff resources to carry out project activities.
The Aboriginal Diabetes Initiative (ADI) Homecare
Enhancement Fund contributed the only additional
resources – $17,464.08 to cover costs associated with
contracting an SMS training expert, and providing
webinar and face-to-face training sessions.
In-kind staff time allocation was significant and
invaluable (see Figure 4). Although staff time was
not included in the budgeting of the pilot projects,
it is an important consideration for the scaling and
spread of SMS beyond the pilot projects.
On average in NWT, diabetes accounted for 9% of
all hospitalizations, 10% of discharges, and 15% of
costs ($8.7 million). The implementation of diabetes
self-management programs present significant
opportunities not only to improve patient’s quality of
life and reduce deterioration of their condition, but
also to reduce healthcare costs to the system. The US
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Making the Case for Change